HOW TO KNOW IF YOUR PHYSIO IS RIGHT FOR YOU: SIGNS OF EFFECTIVE TREATMENT AND WHEN TO SEEK ALTERNATIVES

Medically Reviewed and Updated by Dr. Rae Osborn, Ph.D. - May 02, 2025

Choosing a good physiotherapist is important, whether you are recovering from an injury or managing certain health conditions. A good physiotherapist will help ensure effective recovery and long-term well-being. Understanding the principles of effective physiotherapy and recognizing indicators of suboptimal care is essential for informed patient decision-making.

Understanding the Role of Effective Physiotherapy

The goals of physiotherapy are pain management, improved mobility, strength, and range of motion, and injury prevention. Chronic pain and limited mobility can result in a poor quality of life. Physiotherapists, through their knowledge of biomechanics, can also help prevent further injury by teaching the correct way to move, e.g., the right way to lift objects. Physiotherapy is an essential part of rehabilitative treatment with a broad scope, encompassing sports injuries and musculoskeletal disorders, as well as neurological and cardiorespiratory conditions.

A comprehensive, holistic approach that addresses the underlying etiology of pain and disability is paramount in effective physiotherapy. This model acknowledges the significant influence of psychological and lifestyle factors on patient outcomes. Evidence supports the efficacy of holistic physiotherapy, demonstrating its benefits in managing various conditions, ranging from lower back pain to cerebral palsy. Pain can lead to psychological issues, which holistic physiotherapy can also address.

Key Indicators of Effective Physiotherapy

Below, we outline key attributes aligned with the principles of physiotherapy that contribute to effective patient care. It is particularly important to find a physio who is comfortable and confident in treating your specific condition.

• Licensed and Certified Professionals:

When seeking a physiotherapist, it is essential to verify their credentials. Ensure they are licensed or certified to practice in your state or country. This signifies their adherence to professional standards and validates their ability to provide safe and effective patient care.

• Clinic Environment:

The clinic should have a clean, comfortable, and professional environment with the necessary equipment. Hygiene is important in physiotherapy clinics; physios should wash their hands often to prevent any spread of infection.

Physios should be aware of both passive and active treatments. Effective treatment may involve combining the two methods. Passive methods are used to decrease pain and inflammation. Manual therapy, a hands-on approach, has traditionally been viewed as a passive approach, but it can also form part of an active treatment plan. Active methods involve targeted movements to help improve mobility and range of motion. In some cases, active assistive methods are needed, where the patient requires assistance with movement. Active methods, where the patient is mobilized, are also helpful after certain surgical methods, such as knee replacement surgery. A combined approach of active and passive methods can help increase your chances of long-term recovery and reduce the need for painkillers.

• Thorough Assessment and Diagnosis:

A physiotherapist performs a thorough assessment, working with you to identify the precise areas of pain and seeks to understand how your daily activities impact your symptoms. For example, if a particular movement worsens or causes pain in your back. 

A physical exam, patient interview, and medical history are important components of the assessment. It may be helpful to write down your medical history and take it with you to your appointment. A manual assessment should be done with the physio using their hands to palpate and evaluate the regions of the body that are causing your discomfort.

Functional tests should be done to evaluate how your condition impacts your life on an everyday basis. Your muscle strength and range of motion should be assessed by the physio. Flexibility, coordination, and balance should also be evaluated. The physio uses a scale to numerically record how much pain an activity causes you. This initial assessment establishes your baseline condition, enabling the physiotherapist to track your progress and measure your achievements throughout the therapy.

• Proper Medical Record Keeping

It is important to ensure that your physiotherapist maintains clear and accurate records of your treatment. This includes specific details such as the number of shocks delivered during shockwave therapy or the length and quantity of needles used in dry needling, when these methods are used. With shockwave therapy, it is important for the physio to also record details such as intensity and number of sessions, which vary according to the specific injury being treated. It is essential that your physio notes your response to dry needling so they can adjust the method as needed.

Consistent medical record keeping supports continuity of care, enables effective monitoring of your progress, and helps guide any necessary adjustments to your treatment plan. It also ensures that, if needed, other healthcare professionals can understand your treatment history and make informed decisions about your care.

• Open Communication and Active Listening:

A good physio involves patients in the decision-making process. Informed decisions are a crucial part of a treatment plan. You should feel comfortable discussing your treatment with the physiotherapist and communicating with the physio about any increased pain or other concerns you may have. Effective physiotherapists are responsive and good communicators who interact well with their patients.

• Personalized Treatment Plans:

An effective physiotherapist customizes treatment based on individual needs, health conditions, and lifestyle. They set goals with clear time frames, number of sessions, and frequency of visits. Such an approach is especially significant when recovering from an injury or for alleviating pain from a chronic condition. A personalized physical therapy approach can also be more cost-effective.

• Progressive Improvement:

Effective treatment includes pain relief and leads to gradual improvement in symptoms and function. In general, you should show some improvement after the initial few sessions with a physio if they are providing high-quality care.

Regular monitoring, reassessments, and adjustments to the therapeutic plan are essential facets of your recovery journey. This may include incorporating functional and resistance exercises into your treatment plan as you make progress. Functional resistance-type exercises increase muscle fitness.

Some discomfort after a physiotherapy session is normal, but it should subside. The muscle tissue may feel sore as you move the affected areas, but this should lessen with time. Keep your physio informed if the pain increases in intensity so they can alter your treatment accordingly if needed.

• Education and Empowerment:

A good physio will educate you about your condition. They should also provide you with strategies you can use at home and suggest lifestyle modifications. Physiotherapy exercises done at home can have benefits in maintaining the progression of recovery. Lifestyle modifications can help prevent further injury and thus form an important component of physiotherapy.

An effective physiotherapist can explain why they recommend particular exercises and treatment methods. This should give you confidence in the process.

To ensure optimal quality of care, physiotherapists are required to stay up to date through continuing education and follow the standards set by professional bodies.

Red Flags

Recognizing potential warning signs is crucial when working with a physical therapist. Being informed about these indicators can help you advocate for your care.

Worsening Symptoms After Treatment

• Incorrect physical therapy techniques: If your physical therapist consistently employs the same method without variation, and you experience no noticeable progress, this could indicate a lack of professional judgment and may warrant further evaluation.
• Physical therapy makes pain worse: At first, you may experience some discomfort with physiotherapy, but it should not last or make the pain significantly worse. Consistent worsening of symptoms is a red flag.

Symptom-focused Treatment Without Addressing the Root Cause

• Effective physical therapy requires addressing the root cause of pain and dysfunction, not just the symptoms. Focusing solely on symptom relief provides temporary comfort but risks recurring problems. A competent physiotherapist prioritizes comprehensive assessment to identify and treat the underlying issue for long-term recovery.

Over-reliance on Imaging or Rigid Diagnoses

• While imaging can be helpful, it should not be the sole basis for diagnosis. Too much emphasis on imaging may not be helpful because some findings may not be related to the patient’s problem. Imaging is only one component of diagnosis. Medical history and a hands-on approach are equally important in diagnosis.
• It is important to note that in some cases, the reverse happens, where the physiotherapist does not consider the scans. Imaging methods like CT scans, MRIs, and X-rays can be useful in physiotherapy. Scans may provide more insight into why a person has pain and limited mobility. They can aid in diagnosis and help a physiotherapist in adjusting treatment methods.

Lack of Communication and Collaboration

• This includes not addressing the patient’s concerns and feedback. During a physiotherapy session, the patient should feel comfortable communicating how they are feeling and any worries they may have.
• A good physiotherapist will have empathy, show compassion for their patient, and be willing to spend the time needed to understand their concerns. A good therapeutic relationship is important, with shared decision-making leading to better patient outcomes.

No Progress and Stagnation

• Lack of improvement over time suggests ineffective treatment. This can be due to repetition and a lack of variation in therapeutic techniques, neglect in monitoring progress, or failure to use an optimal mix of passive and active treatments.

Unprofessional or Uncomfortable Environment

• Lack of supervision and individualized care: Your physiotherapist should provide care and a treatment plan that is individually tailored for you. Therapists should supervise the sessions to ensure the patient is comfortable during the administration of modalities such as electrical or heat therapies. They should also monitor any exercises performed during the session to avoid further injury and use measurement instruments to diagnose conditions and assess progress.
• Not having the right equipment/resources: A physiotherapy clinic should have the requisite equipment for patients’ needs. For instance, equipment such as exercise bikes, treadmills, and exercise balls should be available for patients to use as part of their treatment plan.
• Non-availability of schedules/appointments: A responsive physiotherapist ensures that booking appointments is simple and aligned with your schedule and needs.

Lack of Billing Transparency

• There should be transparency regarding treatment costs, with patients informed beforehand about the total cost and inclusions. There should also be a clear breakdown of individual session costs.

Addressing Concerns or Dissatisfaction

If physical therapy is not helping:

• It is important that you communicate your concerns with the physio. This gives the physio an opportunity to adjust your treatment program or provide further advice.
• Ensure you follow your treatment plan accurately and consistently. Adhering to your physiotherapist’s guidance is key — this includes attending scheduled appointments, completing prescribed home exercises, making recommended lifestyle changes, and maintaining realistic expectations about progress.
• Seek a second opinion or find a new physiotherapist if you are unhappy with your progress. 

How to Find a Good Physical Therapist: Tips and Considerations

• Importance of referrals from trusted sources and patient reviews: Online reviews can be helpful when searching for a good physical therapist. Referrals from work colleagues, family, and friends can help you find a trusted practitioner.
• Research physiotherapists and their areas of expertise: There are various physiotherapy subspecialties, including geriatric and sports physiotherapy. You should search for a physiotherapist who best matches your needs. In other words, if you have a sports injury, then a sports physio would be the best choice.
• Importance of checking credentials and certifications: Physiotherapists should be able to demonstrate that they are qualified and have the required certifications and credentials to practice in your location. For instance, in the US, a physiotherapist has to have a Doctor of Physical Therapy (DPT) degree and have passed a state licensing exam. The required qualifications and credentials of a physio will vary depending on where you live.
• An initial consultation with a physiotherapist is important: This gives you an idea of what will be involved in treatment, as well as the time needed and costs.

FAQ

Is Physical Therapy Supposed to Hurt?

No, physical therapy is not supposed to hurt, although there may be some minor soreness initially.

What Happens If Physical Therapy Does Not Work?

You can see if your therapist can modify your treatment plan. Other options can include getting a second opinion or making positive lifestyle changes, which can support your recovery (depending on the underlying condition). Since the reasons physiotherapy may not be working can vary widely, a medical review might be needed to assess your condition and explore appropriate alternative treatments or adjustments to your care plan.

How Long Does It Take to Start Seeing Results From Physical Therapy?

How quickly you see improvements after physical therapy depends on the type and severity of the injury you have. For instance, recovery from minor sprains may take a few weeks, but recovery after surgery usually takes longer (ACL surgery recovery can take at least 9 months).

How Long Does Physical Therapy Last, and What Is the Expected Duration of Each Session?

A physiotherapy treatment session normally lasts about 30 minutes to an hour. However, many factors impact the duration (and the number of sessions needed), including the type of injury or condition you have. For example, one study found that post-surgery patients often do best with physiotherapy that lasts 29 minutes.

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